Provider Demographics
NPI:1780673194
Name:AMBLER, DUSTIN M (CRNA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
Last Name:AMBLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 COUCH AVE
Mailing Address - Street 2:ST. JOE HOSPITAL OF KIRKWOOD
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5536
Mailing Address - Country:US
Mailing Address - Phone:573-636-3483
Mailing Address - Fax:573-636-5315
Practice Address - Street 1:1445 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-2853
Practice Address - Country:US
Practice Address - Phone:573-636-3483
Practice Address - Fax:573-636-5315
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO154946367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered